- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $10,471.29 / $18,197.01
| Facility | | $1,778.28 | $10,471.29 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $6,918.31
| Facility | | $1,548.82 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,096.48 / $1,202.26
| Facility | | $707.95 | $1,096.48 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,698.24
| Professional | | $1,202.26 | $1,202.26 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $1,548.82
| Facility | | $707.95 | $954.99 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $10,471.29
| Facility | | $1,479.11 | $6,760.83 | $10,471.29 |